Comparison of Thoracic Epidural and Intravenous Analgesia from the Perspective of Recovery of Respiratory Function in the Early Post-Thoracotomy Period in Lung Cancer Surgery

Omaygenç, Derya Özden; Çıtak, Necati; İşgörücü, Özgür; Ulukol, Ayşe; Büyükkale, Songül; Obuz, Çiğdem; Doğru, Mustafa Vedat; Sayar, Adnan

doi:10.5152/turkthoracj.2021.19114

Cited by 5 publications

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“…TEA is considered the gold standard technique in pain management after thoracic surgery [2][3][4]10,14]. However, the use of anticoagulants, the invasive nature of the procedure, and difficulties associated with needle insertion limit the use of TEA.…”

Section: Discussionmentioning

confidence: 99%

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Postoperative Analgesic Efficacy of Thoracic Paravertebral Block and Erector Spinae Plane Block Combination in Video-Assisted Thoracic Surgery

Zengin¹,

Baldemir²,

Ulger³

et al. 2021

Cureus

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BackgroundThe combination of a thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) has not been investigated. We aimed to evaluate the effects of the combination of TPVB and ESPB particularly on postoperative pain scores in patients undergoing video-assisted thoracic surgery (VATS). MethodsFrom January 1, 2021, to March 1, 2021, 13 patients older than 18 years who underwent combined ESPB and TPVB for analgesic treatment after elective VATS were included in the study. Standard anesthesia induction was performed for all patients, and the block was performed in the lateral decubitis position before surgery. Using the in-plane technique, an ultrasound (US)-compatible 22-gauge, 8-mm nerve block needle was introduced 2-3 cm lateral to the spinous process of the T6 vertebra and advanced in the caudocranial direction. Fifteen (15) ml of 0.25% bupivacaine was administered and pleural depression was observed. The same needle was withdrawn from the paravertebral space and advanced into the interfascial plane above the transverse process and below the erector spinae muscle at the T5 level. Then, 15 ml of 0.25% bupivacaine was injected. ResultsThe combination of TPVB and ESPB was performed in 13 patients. The mean age was 44.3 (21-68) years. The mean body mass index (BMI) was 23.21 (16.9-35.9) kg/m 2 . Postoperative 24 hours morphine consumption was 24.5 (16-42) mg. In three cases, visual analog scale (VAS) scores at rest were ≥4; therefore, tramadol (25 mg, IV) was given as an additional analgesic. Nausea and vomiting were observed in only one case in the early postoperative period. ConclusıonsAs a new technique, the combination of TPVB and ESPB in this preliminary study provided effective postoperative pain management along with the use of morphine in acceptable quantities. Large-scale, randomized-controlled, and comparative studies are needed to demonstrate the efficacy of the combination of TPVB and ESPB.

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Section: Discussionmentioning

confidence: 99%

“…VATS is a less invasive and less painful procedure as compared to thoracotomy [1]. Thoracic epidural analgesia (TEA) remains to be the gold standard in the treatment of postoperative pain in thoracic surgery [2][3][4]. Thoracic paravertebral block (TPVB) is another technique for pain management after VATS [5].…”

Section: Introductionmentioning

confidence: 99%

Postoperative Analgesic Efficacy of Thoracic Paravertebral Block and Erector Spinae Plane Block Combination in Video-Assisted Thoracic Surgery

Zengin¹,

Baldemir²,

Ulger³

et al. 2021

Cureus

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“…One of the most important components of multimodal analgesia is regional techniques (6)(7)(8). TEA and TPVB are regional methods that have been used for many years in pain after thoracotomy (10,11).…”

Section: Discussionmentioning

confidence: 99%

“…Although the risk of spinal hematoma is not as high as in thoracic epidural catheterization, a normal coagulation profile is also required in block applications (9). TEA is still considered the gold standard technique for post-thoracotomy pain (10)(11)(12). The paravertebral space is a wedge-shaped space that extends on either side of the vertebral column and contains formations such as the spinal nerve, dorsal ramus, rami communicantes, and sympathetic chain (6).…”

Section: Introductionmentioning

confidence: 99%

Comparison of thoracic epidural analgesia and thoracic paravertebral block in pain management after thoracotomy

Zengin

Baldemir

Ulger

et al. 2022

Anatolian Current Medical Journal

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Aim: Thoracotomy is among the most painful surgical incisions and causes severe acute pain in the postoperative period. Many analgesic methods have been suggested for thoracotomy pain treatment. Thoracic epidural analgesia (TEA) and thoracic paravertebral block (TPVB) are common regional methods for post-thoracotomy pain. In this study, we aimed to compare the efficacy and the side effects of TEA and TPVB methods applied for post-thoracotomy analgesia. Material and Method:After ethical committee approval, we retrospectively analyzed postoperative analgesia records of patients, who underwent thoracotomy, received TEA or TPVB for postoperative analgesia between 01.01.2019 and 01.01.2021. Visual analog scale (VAS) scores of the patients who received analgesic treatment for 24 hours postoperatively after TEA or TPVB application were evaluated.Results: Data of 474 patients were found eligible for analysis. Demographic data of patients, VAS scores, patient satisfaction, and additional analgesic requirements were not statistically significant between the groups (p>0.05). Nausea-vomiting, hypotension, headache, itching, and sweating was statistically significantly higher in the TEA group when compared to patients who underwent TPVB (p<0.05). Conclusion:In the present study, in the early postoperative pain management after thoracotomy; it was observed that preemptive TPVB and postoperative IV patient-controlled analgesia (PCA) and TEA provided similar VAS scores and additional analgesic requirements. On the other hand, postoperative complications were observed less frequently in patients who underwent TPVB with postoperative IV PCA compared to TEA. Therefore, TPVB may be a good alternative to prevent acute pain after thoracotomy.

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“…When patients complained of intolerable pain, an additional 50 mg tramadol was administered intravenously. The visual analog scale (VAS) score, which was explained to the patients the day before the operation, was used to de ne pain severity [13]. We used a traditional scale ranging from 0 to 10.…”

Section: Pain Control and Assessmentmentioning

confidence: 99%

Outcomes of Video-Assisted Thoracoscopic Wedge Resection Using a Non-Crushing Clamp and Continuous Sutures Plus Hemovac Drains Versus Staplers Plus Conventional Chest Tube: A Comparative Study

Fazlıoğlu

2024

Preprint

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OBJECTIVES. In thoracoscopic surgery, we described wedge resection of the parenchyma with clamps and subsequent use of hemovac drains and compared it with the standard technique of using staplers and conventional chest tubes. METHODS. Fifty-nine patients who underwent thoracoscopic wedge resection between 2018 and 2024 were retrospectively analyzed. Patients were divided into two groups according to the surgical and drain types: stapler plus chest tube (S-ct, n = 27) and clamp plus hemovac drain (C-hd, n = 32). Air leak duration, postoperative drainage time, hospital stay duration, and total medical costs were also investigated. RESULTS. There were no significant differences in patient characteristics between both groups. The operation time was longer in Group C-hd (median 70 min versus median 60 min, p = 0.115). Prolonged air leak rates were similar between the two groups (11.1% and 12.5% in Groups S-ct and C-hd, respectively). The air leak duration and postoperative drainage time were not statistically significantly different between both groups (p = 0.872 and p = 0.176, respectively). The VAS scores on the first postoperative and day were significantly lower in Group C-hd (p = 0.02, and p = 0.02, respectively). Pain requiring additional treatment was significantly higher in Group S-ct (33.3% vs. 9.4%, p = 0.04). Total medical cost was statistically significantly higher in Group S-ct (median 371.7 vs. 191.6 dollars, p < 0.001). CONCLUSION. In thoracoscopic surgery, wedge resection of the parenchyma with clamping and subsequent use of a hemovac drain are comparable to the standard technique of using staplers and conventional chest tubes regarding short-term results and better economic results. Hemovac drainage can reduce postoperative pain.

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Comparison of Thoracic Epidural and Intravenous Analgesia from the Perspective of Recovery of Respiratory Function in the Early Post-Thoracotomy Period in Lung Cancer Surgery

Cited by 5 publications

References 0 publications

Postoperative Analgesic Efficacy of Thoracic Paravertebral Block and Erector Spinae Plane Block Combination in Video-Assisted Thoracic Surgery

Postoperative Analgesic Efficacy of Thoracic Paravertebral Block and Erector Spinae Plane Block Combination in Video-Assisted Thoracic Surgery

Comparison of thoracic epidural analgesia and thoracic paravertebral block in pain management after thoracotomy

Outcomes of Video-Assisted Thoracoscopic Wedge Resection Using a Non-Crushing Clamp and Continuous Sutures Plus Hemovac Drains Versus Staplers Plus Conventional Chest Tube: A Comparative Study

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